Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, F-69437 Lyon, France; Université de Lyon, VetAgro Sup, Campus Vétérinaire de Lyon, UPSP 2016.A101, Pulmonary and Cardiovascular Aggression in Sepsis, F-69280 Marcy l'Étoile, France.
Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, F-69437 Lyon, France.
J Crit Care. 2022 Jun;69:154020. doi: 10.1016/j.jcrc.2022.154020. Epub 2022 Mar 17.
Increased respiratory drive and respiratory effort are major features of acute hypoxemic respiratory failure (AHRF) and might help to predict the need for intubation. We aimed to explore the feasibility of a non-invasive respiratory drive evaluation and describe how these parameters may help to predict the need for intubation.
We conducted a prospective observational study. All consecutive patients with COVID-19-related AHRF requiring high-flow nasal cannula (HFNC) were screened for inclusion. Physiologic data (including: occlusion pressure (P0.1), tidal volume (Vt), inspiratory time (Ti), peak and mean inspiratory flow (Vt/Ti)) were collected during a short continuous positive airway pressure (CPAP) session. Measurements were repeated once, 12-24 h later.
Measurements were completed in 31 patients after the screening of 45 patients (70%). P0.1 was high (4.4 [2.7-5.1]), but it was not significantly higher in patients who were intubated. The Vt (p = .006), Vt/Ti (p = .019), minute ventilation (p = .006), and Ti/Ttot (p = .003) were higher among intubated patients compared to non-intubated patients. Intubated patients had a significant increase in their diaphragm thickening fraction, Vt, and Vt/Ti over time.
Non-invasive assessment of respiratory drive was feasible in patients with AHRF and showed an increased P0.1, although it was not predictive of intubation.
呼吸驱动增加和呼吸努力是急性低氧性呼吸衰竭（AHRF）的主要特征，可能有助于预测插管的需求。我们旨在探索非侵入性呼吸驱动评估的可行性，并描述这些参数如何有助于预测插管的需求。
我们进行了一项前瞻性观察性研究。所有因 COVID-19 相关 AHRF 需要高流量鼻导管（HFNC）的连续患者均进行了入选筛查。在短暂的持续气道正压通气（CPAP）期间收集生理数据（包括：闭塞压（P0.1）、潮气量（Vt）、吸气时间（Ti）、吸气峰流速和平均流速（Vt/Ti））。12-24 小时后重复测量一次。
在对 45 名患者进行筛查后，有 31 名患者完成了测量（70%）。P0.1 较高（4.4[2.7-5.1]），但在需要插管的患者中并没有显著更高。与非插管患者相比，插管患者的 Vt（p=0.006）、Vt/Ti（p=0.019）、分钟通气量（p=0.006）和 Ti/Ttot（p=0.003）更高。与非插管患者相比，插管患者的膈肌增厚分数、Vt 和 Vt/Ti 随时间显著增加。
在 AHRF 患者中，非侵入性呼吸驱动评估是可行的，尽管它不能预测插管，但 P0.1 升高。
